Policy Concerning Students Exposed to Personal Risk of ...

Policy Concerning Students Exposed to Personal Risk of Serious Infection In the care of assigned patients with serious contagious diseases, such as human immunodeficiency virus infection, hepatitis B or C infection, or tuberculosis, medical students are expected to participate at their level of competence. A medical student should not be penalized for questioning whether his/her personal safety is being compromised unnecessarily. Medical education and training should include instruction intended to maximize the safety of all members of the health care team in situations in which there are increased risks of exposure to infectious agents, including skill in handling or being exposed to sharp objects in diseases transmitted through blood or secretions and in use of appropriate barriers in airborne and hand- to-mouth infections.

Policies for USC SOM on Bloodborne Pathogens Students caring for patients in University of South Carolina School of Medicine (USC SOM)- affiliated teaching hospitals and clinics experience risk of exposure to several infectious diseases, including hepatitis B, hepatitis C, and human immunodeficiency virus. Consequently, these policies state the required actions expected of all USC SOM students involved in patient care to prevent transmission of such infections to themselves and to prevent or minimize clinical disease in the event they undergo significant exposure.

The Centers for Disease Control and Prevention describe the universal precautions approach to preventing fluid borne infections in health care workers. A thorough discussion of this approach is available online (niosh/topics/bbp/universal.html), but the approach can be summarized as follows:

USC SOM students must practice "Universal Standard" (Universal Precautions) when dealing with patients. The actions described as "Universal Standard" (Universal Precautions) include, but are not limited to:

1. use of barrier protection methods when exposure to blood, body fluids, or mucous membranes is possible. 2. use of gloves for handling blood and body fluids. 3. wearing gloves by students acting as phlebotomists. 4. changing gloves between patients. 5. use of a facial shield when appropriate (during all surgery and any other procedures where eye exposure to

airborne material is possible). 6. use of gown and apron for protection from splashing when appropriate. 7. washing hands between patients and if contaminated. 8. washing hands after removal of gloves. 9. avoidance of unnecessary handling of needles or other sharps. 10. careful processing of sharps. 11. appropriate disposal of sharps in sharps containers. 12. avoidance of direct mouth-to-mouth resuscitation contact. 13. minimization of spills and splatters. 14. decontamination of all surfaces and devices after use.

The following actions are specifically required by the USC SOM to minimize risk of transmission of infection: A. Gloves will be worn for all parts of the physical examination in which contact might be expected with the oral, genital, or rectal mucosa of a patient. Gloves are also necessary while examining any skin rash that might be infectious (e.g., syphilis, herpes simplex, etc.) B. Gloves will be worn in all procedures that involve risk of exposure to blood or body fluids, including venipuncture, arterial puncture, and lumbar puncture. Gloves will also be worn during any laboratory test on blood, serum, or other blood product, or body fluids.

C. Prior to performing a venipuncture, obtain a needle (and syringe) disposal box and place it adjacent to the venipuncture site. After venipuncture, insert the needle (and syringe) immediately in the disposal box. DO NOT recap or remove needles by hand. Care must be taken to avoid bringing the needle near the body of other persons in the examining room while transferring it to the container. OSHA requires the use of syringes and other "sharps" designed with safety features that permit safe recapping/closure using one handed techniques and reduce the overall risk needlesticks. These safety devices should be in use at the locations where students rotate. Students should use these safer devices while on clinical rotations and should obtain training from nurses or physicians experienced with using the particular type of device prior to using it themselves. If a safety device does not appear to be readily available, students are strongly encouraged to ask the nurse manager about the availability of a safety device.

D. Protective eyeware (such as goggles or a face shield) should be worn when participating in surgical procedures or other activities in which exposure to airborne blood or body fluids (via aerosolization or splashes) may occur.

Post Exposure Evaluation and Follow-Up Following a report of blood/body fluid exposure incident, the USC School of Medicine shall make immediately available to the exposed student a confidential medical evaluation and follow- up that includes the following elements:

? Documentation of the route(s) of exposure, and the circumstances under which the exposure incident occurred;

? Identification and documentation of the source individual, unless the employer can establish that identification is infeasible or prohibited by state or local law;

? The source individual's blood shall be tested as soon as feasible in order to determine HBV and HIV infectivity. South Carolina law permits testing of source patients to be performed, even without consent, with proper legal authority.

? Results of the source individual's testing shall be made available to the exposed student, and the student shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.

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